Prediction of mortality rate after major hepatectomy in patients without cirrhosis

Abstract

Objective: To assess the ability of preoperative biological parameters to predict a fatal outcome after a major liver resection in patients without cirrhosis.

Design: Retrospective descriptive cohort study.

Setting: Department of Digestive Surgery and Transplantation, University of Strasbourg.

Patients: From January 1, 2004, through December 31, 2007, 67 consecutive patients underwent resection of at least 4 contiguous liver segments.

Main outcome measures: Perioperative data were prospectively recorded, and predictors of postoperative mortality rate and liver failure were analyzed.

Results: Five patients (7%) died after a mean (SD) of 32.4 (11.8) postoperative days. The overall morbidity was 73% (49 patients). Univariate analysis revealed that a preoperative alanine aminotransferase blood level greater than 40 U/L (to convert to microkatals per liter, multiply by 0.0167), a preoperative prothrombin ratio less than 70%, a preoperative Indocyanine green retention rate at 15 minutes of greater than 15%, preoperative biliary drainage, and performance of extrahepatic bile duct resection significantly predict the occurrence of in-hospital death. The number of preoperative biological parameters in each patient significantly increased the mortality rate. Indeed, the mortalities were 0%, 3%, and 67% in patients presenting with none, 1, and 2 or more risk factors, respectively.

Conclusions: This study shows that preoperative liver tests and function can predict postoperative fatal outcome in patients presenting with biliary carcinomas and requiring a major liver resection. On the basis of these preoperative biological parameters, a decision-making algorithm is provided.